Care Home: Alexandra Centre For Physical Disability &Sensory Impairment

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What the care home does well The home`s pre admission procedure is good and prospective residents are provided with information about Alexandra Centre and are encouraged to visit, in advance of admission, to establish their impressions of life at the home and the standard of available accommodation. Individual plans and risk assessments are detailed, person-centred and informative ensuring residents and staff are fully aware of how needs and goals are to be met. People are able to make a range of choices about their daily lives. Residents are supported and encouraged to participate in activities, which interest them, to be part of their local community and to maintain links with family and friends so that they have networks of support outside of their home. Daily routines in the home promote residents` independence and there is a flexible approach to mealtimes, which promotes residents` well-being and enjoyment of their meals. Access to generic and specialist health care services ensure that residents` physical and mental health care needs are well met. People living at the Alexandra Centre can feel confident that staff members will listen to any issues they raise and there are policies and procedures in place, which raise awareness of abuse and protect people living at the service from harm. The home is maintained, decorated and furnished to a good standard. It is clean and hygienic with appropriate aids and adaptations in place. The environment, therefore, provides a safe, homely and comfortable place for people to live. Well-trained and supervised staff members are able to fulfil the needs and preferences of people living in the home. Clear management structures, and regular consultation with people living at the service, supports the running of the home in the best interests of residents. Good practices and procedures protect the safety and welfare of residents. What has improved since the last inspection? Following the last key inspection and random unannounced specialist pharmacy inspection, improvements have been made in many areas within the home. Full social care plans have been implemented to support residents to experience a varied and active lifestyle. Some improvements have been made to the policy and systems for the administering and handling of medication, including: medicines returned to the pharmacy are now signed as received by the pharmacist; a system for auditing the safe handling of medicines must has been devised, ensuring that there is a clear audit trail for each medicine from receipt, to administration or disposal. Medicines are now signed for at the time of administration and a tablet cutter is now used to ensure that the required dose of tablets can be efficiently administered. Staff members administering medication also check the prescribed instructions for each medicine, before administering medication. The complaint`s policy has been amended to include the details of the Commission for Social Care Inspection, as the regulatory body. Recruitment procedures have improved and the home now ensures all references and statutory checks are obtained before the applicant starts working at the home. Staff members wear disposable aprons or over garments when working in the kitchen, serving food, or helping residents with eating, to reduce the risk of cross infection. A written annual development plan has been developed, supporting the running of the home in the best interests of residents. This now includes an action plan of how, when and by whom, development will be achieved. The registered manager is working towards, a management qualification, which is equivalent to the Registered Manager`s Award. Internet access is now available in the home, to support the running of the service for the benefit of residents, in accordance with current good practice guidelines. What the care home could do better: One requirement and three good practice recommendations have been made as a result of this inspection. (The home has already made good progress in meeting these and provided some documentation to support it, received on 29/05/08 and this will be reviewed at the next inspection.) Some improvements have been made in the storage of medication but this needs to continue to ensure that medicines are safely administered, recorded, stored and disposed, protecting residents from the risk of harm. All hand written entries must be double signed by two competent members of staff. The home should give consideration to how medicine records are signed and this information documented clearly, with a list of staff signatories held. Consideration should be given to how gaps in potential employees work histories are explored and recorded. The homes quality assurance process should be improved by finding a method to record stakeholders` opinions of the running of the home. CARE HOME ADULTS 18-65 Alexandra Centre For Physical Disability &Sensory Impairment 23 Howard Road Queens Park Bournemouth Dorset BH8 9EA Lead Inspector Jo Pasker Unannounced Inspection 18th March 2008 11:00 Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alexandra Centre For Physical Disability &Sensory Impairment 23 Howard Road Queens Park Bournemouth Dorset BH8 9EA 01202 528420 01202 528420 alexandracentre@hotmail.co.uk www.alexandracentre.co.uk Care Services (Bournemouth) Ltd trading as Alexandra Centre for Physical Disability Mrs Sylvia Jean Rundell Care Home 14 Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Category(ies) of Physical disability (14), Sensory impairment registration, with number (14) of places Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Day care provision for a maximum of 5 service users in the category PD. 11th September 2006 Date of last inspection Brief Description of the Service: The Alexandra Centre for Physical Disability and Sensory Impairment is registered to accommodate up to 14 residents. Two bedrooms are registered as doubles but only one is currently used for shared occupancy. The home has been specially adapted to meet the needs of this group of younger service users. An attractive conservatory and patio area provide extra communal space and many of the occupational and leisure activities take place in these areas. Alexandra Centre is fully equipped to ensure a totally inclusive environment for each individual. There is a garden, which can be accessed via a ramp for wheelchair users. The home is located in a quiet residential area but close to all local amenities. Alexandra Centre offers both a caring yet busy and positive environment for the people living there. The Centre has its own bus, which can accommodate up to four wheel chair users and also has a smaller vehicle for one wheelchair user, a driver and a carer. Mr Nathoo, who is the Registered Provider, owns the home and there is a Registered Manager, Mrs Jean Rundell, who deals with the daily running. The fee prices in March 2008, range from £650-£1100 per week. The fees are negotiated based on each individual’s assessment of needs. The fee does not include hairdressing, chiropody and transport. See the following website for further guidance on fees and contracts: www.oft.gov.uk (Value for Money and Fair Terms in Contracts). Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced key inspection was undertaken in line with the Care Standards Act 2000 and following the Commission’s Inspecting for Better Lives guidance. Since the last key inspection, a random unannounced specialist pharmacy inspection has also taken place on the 21 September 2006 and this report can also be viewed upon request. This was a statutory inspection and was carried out to ensure that the residents who are living at the Alexandra Centre are safe and properly cared for. Requirements and recommendations made as a result of the last inspection visit were reviewed. Information for this report was obtained from discussion with the Registered Manager, discussions with 4 residents, 5 members of staff on duty, a review of a variety of documentation including records provided to the Commission, care records, staff records, maintenance records, policies and procedures and a tour of the home. The annual quality assurance assessment (AQAA) sent before the inspection had been completed and returned. Comment cards were received back from 7 residents, 4 GP’s, 1 external health and social care professional, 5 staff and 5 relatives/friends. Friends or family members had completed some resident survey forms on behalf of residents. The Registered Manager was available throughout the inspection and was extremely helpful, as were all of the staff on duty. Comments received included: • ‘The home is first class. My son needs 24 hour care and is very happy’ • ‘The care home is what it says “a care home”, very homely and considerate with good staff who make a great difference’ • ‘Provides an environment as much like the service users’ homes as possible with freedom and safety considered’. What the service does well: The home’s pre admission procedure is good and prospective residents are provided with information about Alexandra Centre and are encouraged to visit, in advance of admission, to establish their impressions of life at the home and the standard of available accommodation. Individual plans and risk assessments are detailed, person-centred and informative ensuring residents and staff are fully aware of how needs and Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 6 goals are to be met. People are able to make a range of choices about their daily lives. Residents are supported and encouraged to participate in activities, which interest them, to be part of their local community and to maintain links with family and friends so that they have networks of support outside of their home. Daily routines in the home promote residents’ independence and there is a flexible approach to mealtimes, which promotes residents’ well-being and enjoyment of their meals. Access to generic and specialist health care services ensure that residents’ physical and mental health care needs are well met. People living at the Alexandra Centre can feel confident that staff members will listen to any issues they raise and there are policies and procedures in place, which raise awareness of abuse and protect people living at the service from harm. The home is maintained, decorated and furnished to a good standard. It is clean and hygienic with appropriate aids and adaptations in place. The environment, therefore, provides a safe, homely and comfortable place for people to live. Well-trained and supervised staff members are able to fulfil the needs and preferences of people living in the home. Clear management structures, and regular consultation with people living at the service, supports the running of the home in the best interests of residents. Good practices and procedures protect the safety and welfare of residents. What has improved since the last inspection? Following the last key inspection and random unannounced specialist pharmacy inspection, improvements have been made in many areas within the home. Full social care plans have been implemented to support residents to experience a varied and active lifestyle. Some improvements have been made to the policy and systems for the administering and handling of medication, including: medicines returned to the pharmacy are now signed as received by the pharmacist; a system for auditing the safe handling of medicines must has been devised, ensuring that there is a clear audit trail for each medicine from receipt, to administration or disposal. Medicines are now signed for at the time of administration and a tablet cutter Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 7 is now used to ensure that the required dose of tablets can be efficiently administered. Staff members administering medication also check the prescribed instructions for each medicine, before administering medication. The complaint’s policy has been amended to include the details of the Commission for Social Care Inspection, as the regulatory body. Recruitment procedures have improved and the home now ensures all references and statutory checks are obtained before the applicant starts working at the home. Staff members wear disposable aprons or over garments when working in the kitchen, serving food, or helping residents with eating, to reduce the risk of cross infection. A written annual development plan has been developed, supporting the running of the home in the best interests of residents. This now includes an action plan of how, when and by whom, development will be achieved. The registered manager is working towards, a management qualification, which is equivalent to the Registered Manager’s Award. Internet access is now available in the home, to support the running of the service for the benefit of residents, in accordance with current good practice guidelines. What they could do better: One requirement and three good practice recommendations have been made as a result of this inspection. (The home has already made good progress in meeting these and provided some documentation to support it, received on 29/05/08 and this will be reviewed at the next inspection.) Some improvements have been made in the storage of medication but this needs to continue to ensure that medicines are safely administered, recorded, stored and disposed, protecting residents from the risk of harm. All hand written entries must be double signed by two competent members of staff. The home should give consideration to how medicine records are signed and this information documented clearly, with a list of staff signatories held. Consideration should be given to how gaps in potential employees work histories are explored and recorded. The homes quality assurance process should be improved by finding a method to record stakeholders’ opinions of the running of the home. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. An inclusive assessment of residents’ needs and wishes is carried out prior to residents moving into the home, enabling people to be assured that their needs and aspirations will be met by the service. EVIDENCE: The pre-admission assessment was viewed for one resident who had recently moved into the home and this showed that Alexandra Centre continues to have a good pre admission assessment procedure in place. Peoples’ needs are assessed before moving to the home and sufficient information is obtained so that a suitable plan of care can be written based on this. For example, this person had been identified as being at risk of falling out of bed and a falls risk assessment and care plan, of how to safely minimise this was also included in their care file. Appropriate bed rails were also in place. All 7 residents replying to surveys stated that they had received enough information about the home before they moved in, to help them decide whether it was right for them. One resident commented ‘I had already spent a week in this care home and liked it’. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 11 Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans and risk assessments are detailed, person-centred and informative ensuring residents and staff are fully aware of how needs and goals are to be met. People are able to make a range of choices about their daily lives and are involved in decision making within the home. EVIDENCE: The individual plans of 2 residents were seen. Both contained detailed information on aspects of personal and social support, healthcare needs, leisure activities and independent living skills. These individual plans were dated and signed by the resident or family to evidence that they had discussed and agreed them and there was written evidence of recent reviews taking place. There was documented evidence in the daily entry notes of staff addressing individuals’ goals and staff spoken with, confirmed that they were aware of individual’s needs and any interventions preferred. These files also contained photographs of the residents. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 13 At the last inspection, a recommendation was made, that all residents should have full social care plans in place to support them in experiencing a varied and active lifestyle. This has now been addressed by the home and both residents’ files had detailed social histories and care plans in place. People were seen being supported to make their own decisions. These included making their own drinks when they liked, choosing to eat when it suited them and going out at different times of the day. Residents spoken with confirmed that they could choose what to do, with some going to the shops or out with friends and family. One resident particularly enjoys watching international sporting events on television, which are often shown at unsocial hours and the home ensure that this activity is accommodated. Of the 7 resident surveys returned, 3 replied ‘always’, 2 ‘usually’ and 2 ‘sometimes’, when asked ‘Do you make decisions about what you do each day?’ Detailed risk assessments continue to be carried out in relation to nutrition, manual handling, falls and the risk of pressure sores as well as for specific areas of identified risk. Risk assessments are recorded when a resident moves into the service, enabling any potential risks or hazards to be identified and action planned to minimise the presenting risks. The home uses clinical assessment tools to assess specific aspects of healthcare and support and evidence was also seen of consultation with appropriate healthcare professionals. For example, one person with swallowing difficulties had received a speech and language therapy (SALT) assessment and as a result, had a ‘safe swallow plan’ in place which all staff, caring for that person, were familiar with. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported and encouraged to participate in activities, which interest them, to be part of their local community and to maintain links with family and friends so that they have networks of support outside of their home. Daily routines in the home promote their independence and there is a flexible approach to mealtimes. EVIDENCE: Information supplied by the Registered Manager in the AQAA indicated that residents take part in a range of activities in their local community. This includes attendance at various day centres, community working and attendance at church according to personal preferences. Weekly programmes of individuals’ activities are kept in an activities diary and in discussion, residents confirmed that they attended different activities throughout the week. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 15 The home employs 2 activity organisers and during the course of the inspection, some residents had gone out and others were seen involved in an art activity. The activity organiser ensured that people with differing levels of ability could take part and there was a happy, relaxed atmosphere. Some residents prefer not to participate in organised activities but they are assisted and encouraged to maintain any interests they do have and bed bound residents are visited in their rooms. Regular outings are arranged by the home and places to visit are decided with the residents. The home has it’s own minibus and smaller wheelchair accessible vehicle. Relatives and friends are made feel very welcome and there is a warm atmosphere in the home. Many visitors were seen coming and going during the day, some visiting with dogs and babies. Family and friends are always encouraged to take part in the many social events that are held with the home and photos on the walls display different occasions. Staff treat people with dignity and respect individuals’ personal choices and preferences, knocking on doors and referring to people by their preferred name. The residents choose the menu and lunch was seen to be waffles and baked beans on the day. They are able to eat at times that suit them and a wide variety of meals are available. The kitchen was clean and tidy, with plenty of food storage and fresh fruit available. Residents spoken with said they enjoyed the food and having the ability to decide what to eat and when. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff have a good understanding of residents’ care needs and support is offered in a way that promotes independence and respects personal preferences. Access to generic and specialist healthcare services, ensures that residents’ physical and mental health care needs are well met. Improvements to the home’s medication handling and procedure mean people are better protected, however there are still some shortfalls in recording. EVIDENCE: Individual plans seen provided staff with enough detail about the care needs and routines of people living in the home, for example, specific positioning programmes from the physiotherapist and the help they need with their personal care. Risk assessments seen also showed evidence that risks around falls and pressure area care had been considered. Staff spoken with showed a clear understanding of residents’ needs and were seen to be kind and caring in their interaction with residents, often sharing a good sense of humour. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 17 The home continue to ensure that individuals’ health care needs, both mental and physical, are properly monitored and appointments made as appropriate. For example, it was noticed that one resident had lost a significant amount of weight over a short period of time and the home had appropriately referred them to the GP and subsequently to a dietician for advice. Residents’ records showed evidence of liaison with generic and specialist health care services, for example GP’s, occupational therapists, specialist nurses and physiotherapists. Of the 4 responses received from GP’s to the surveys sent out, all of them felt that ‘staff demonstrate a clear understanding of the care needs of service users’ and that they are ‘satisfied with the overall care provided’ to residents in the home. Other comments received included: • ‘Whatever the District Nurses have requested the care service have always fulfilled the request and worked with them to achieve best practice’ • ‘They provide excellent pressure area care and have a very friendly environment catering for a diverse variety of needs for patients with multiple disabilities. I cannot fault the home at all’. Following the last key inspection and random unannounced specialist pharmacy inspection, improvements have been made in the administration and handling of medicines within the home. Most medicines in the home are administered from Monitored Dosage System (MDS) cassettes, with no residents selfmedicating at the time of inspection. There is a clear system in place for the ordering, receipt, administration and disposal of medicines, with one of the assistant mangers taking responsibility for this. Returned medicines are now signed for by the pharmacist and a tablet cutter is now used for cutting tablets when needed, ensuring that the correct dosage is received. The medicines trolley was secured to the wall at all times and fridge temperatures were recorded accurately. The Medicine Administration Record (MAR) charts were sampled and there were no gaps seen in recording, allergies were documented and reasons and dosages recorded for ‘as required’ medicines. However, not all handwritten entries seen were counter signed, as the medicine policy reflected. Staff generally only sign the MAR charts with one of their initials and it was discussed with the Registered Manager how this could be confused with some of the codes for non-administration, printed on the chart. (The home has since written to the Commission, received on 29.05.08, that it has addressed these issues and this will be checked at the next inspection.) All staff responsible for the administration and handling of medication also held valid certificates of training. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the Alexandra Centre can feel confident that staff members will listen to any issues they raise and act upon them. The home has policies and procedures in place, which raise awareness of abuse, and support the protecting of people living at the service from harm. EVIDENCE: The home has a clear complaints policy and procedure available to everyone, a copy of which is displayed in the lounge. This has been updated due to changes within the Commission and a copy provided by the home, received on 29.05.08. Neither the Commission, nor the home has received any complaints, since the last inspection. Residents spoken with during the inspection said that if they had any concerns they could raise them in residents’ meetings held and all 7 residents returning surveys cards, indicated that they knew how to complain and who to speak to. The home has an adequate policy and procedure to respond to suspicion or evidence of abuse or neglect and there is ongoing safeguarding training for staff. In discussion, staff were able to identify different types of abuse and appeared familiar with local safeguarding procedures. Of the 5 surveys returned by staff, all of them stated that they knew what to do if a resident, relative or friend had concerns about the home. There have been 2 Safeguarding referrals made regarding residents since the last inspection and Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 19 the home has been advised that these have now been closed. However, the Commission is unable to comment on whether the outcomes of these investigations were found substantiated or not. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is maintained, decorated and furnished to a good standard. It is clean and hygienic with appropriate aids and adaptations in place; the environment, therefore, provides a safe, homely and comfortable place for people to live. EVIDENCE: A tour of the premises found the home remained clean and well maintained, with specific adaptations for wheelchairs users. The AQAA received states that residents are able to choose how their rooms are decorated and furnished; wheel chair height washbasins are available and there is a specialist bath and wet area shower designed for people with physical disabilities. Overhead track hoists are also fitted in many rooms aid with moving and handling. The home has an on going refurbishment plan and dedicated maintenance manager, who is responsible for any work carried out at Alexandra Centre and Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 21 it’s sister home, Farway Grange. Recently work has been undertaken to replace all of the double-glazing in both buildings and new carpets have been fitted. The laundry room appeared clean and tidy and contained adequate facilities for the residents. The AQAA stated that the home had recently bought a new washing machine and tumble drier. All 7 residents responding to the survey indicated that the home is ‘always’ fresh and clean and one relative/friend commented that ‘The cleanliness of the bathrooms is good’. Following a previous recommendation made regarding good infection control practice, all staff now wear appropriate disposable aprons when serving food. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well-trained staff members enable the service to fulfil the needs and preferences of people living in the home. Recruitment practice has improved and ensures that residents living in the home are better protected, however some aspects of recording could be improved. EVIDENCE: All files seen of current staff, contained evidence of training certificates and recent sessions attended including, safe handling of medication, food hygiene and safeguarding training. All mandatory training was seen to up to date on the training matrix and 2 staff members are also undertaking their NVQ 4 award in care currently, with 13 staff already holding an NVQ level 2 or 3 qualification. The Registered Manager is supernumerary and has 3 senior staff that are appointed as assistant managers. Each one has delegated responsibility for different areas, including medication, staff rota and ordering goods. The home also has a designated member of staff responsible for training and Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 23 housekeeping. All staff are also involved in the daily cleaning and cooking within the home. There appeared to be adequate numbers of staff on duty that were seen to clearly communicate with the residents, however some comments from resident and relative surveys returned indicated that they felt this was not always the case. The files of 3 staff members were viewed during the inspection and all required documentation was present, meeting a requirement made at the last inspection. However, no evidence was seen of gaps in work histories being explored and this was discussed with the Registered Manager, regarding best practice. (The home has since written to the Commission, received on 29.05.08, informing them that this has now been implemented and evidence of this will be checked for at the next inspection.) The designated staff member for staff training is using the Skills for Care common induction standards to induct all new staff and evidence of this was seen. Any relevant training is also attended together with local Skills for Care meetings. One half day per week is also dedicated to covering induction only and ensuring that it is carried out to a good standard so that staff are fully aware of their job role and responsibilities. Further information on available training can be accessed through the following websites: www.picbdp.co.uk www.skillsforcare.org.uk Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A well organised home, with clear management structures, and regular consultation with people living at the service, supports the running of the home in the best interests of residents. Additions to the quality assurance process would further improve this. Good practices and procedures protect the safety and welfare of residents. EVIDENCE: Mrs Jean Rundell, the manager of the home, has many years of experience in care provision and management. She is currently working towards the Registered Manager’s Award following a previous recommendation made. Through discussion with staff and comments received from residents and relatives, it was evident that Mrs Rundell is committed to maintaining a high Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 25 standard of care throughout the home and is very approachable. The staff team worked well together and had a clear understanding of their roles and responsibilities, with 1 member of staff, who was responsible for training needs, willing to come in on a day off, to discuss the induction/training process with the inspector. Mrs Rundell acts as a good role model for staff, demonstrating a good rapport and sound knowledge of the needs of each resident and encourages staff to take ownership of their work and delegated responsibilities. Comments received regarding the management of the home included: • ‘My manager is very supportive and reviews my work regularly’ • The home adopts an ‘open door’ policy so at any time you can discuss any needs and alternative training’. The home submitted a completed AQAA prior to the inspection detailing how they currently meet Care Standards and their plans to improve. Residents’ and relatives’ opinions are sought by the home through the use of their annual questionnaires, with results displayed in the home and any issues discussed at the residents’ meetings. This system could be further improved by introducing surveys for external stakeholders also, such as GP’s, district nurses, occupational therapists and physiotherapists. (The home has since written to the Commission, received on 29.05.08 and provided evidence of new survey forms developed that will be used to seek the views of residents, family, friends and healthcare professionals, on the running of the home. Evidence of completed forms will be checked at the next inspection). Following previous recommendations made, internet access for the home and an annual development plan have been implemented. This will help the home plan improvements to the service and ensure that policies and procedures reflect current good practice guidelines. Records showed that staff had all received fire safety training and regular fire checks took place. All substances hazardous to health were seen to be stored securely although it was noted that the temperature of the water from the hot tap in the staff cloakroom’s basin, appeared excessively hot. This was discussed with the Registered Manager and the maintenance manager who stated that it would not have a thermostat fitted, as this is only necessary for water used by residents. However, as this room is accessible to residents it was agreed that a warning sign be put on the door and this was actioned immediately. A sample of safety and maintenance certificates showed that they were up to date and accidents were well documented and stored appropriately. Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000003909.V362331.R01.S.doc 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X 3 3 X Version 5.2 Page 27 Alexandra Centre For Physical Disability &Sensory Impairment Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 Requirement The Registered Provider must ensure that medicines are safely handled and administered; All hand written entries must be double signed by two competent members of staff. (The home have since informed the Commission that this requirement has now been addressed and evidence of this will be checked at the next inspection). Timescale for action 18/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations The home should give consideration to how medicine records are signed and this information documented clearly, with a list of staff signatories held. (The home has already provided some evidence that they DS0000003909.V362331.R01.S.doc Version 5.2 Page 28 Alexandra Centre For Physical Disability &Sensory Impairment are addressing this recommendation and evidence will be checked at the next inspection). 2. YA34 Consideration should be given to how gaps in potential employees work histories are explored and recorded. (The home has already provided some evidence that they are addressing this recommendation and evidence will be checked at the next inspection). The homes quality assurance process should be improved by finding a method to record stakeholders’ opinions of the running of the home. (The home has already provided some evidence that they are addressing this recommendation and evidence will be checked at the next inspection). 3. YA39 Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alexandra Centre For Physical Disability &Sensory Impairment DS0000003909.V362331.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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